Journal of orthopaedic trauma
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The aim of this study was to investigate the outcome after an isolated humeral shaft fracture treated primarily nonoperatively with a fracture brace. ⋯ This study confirms the high overall rate of union of humeral shaft fractures and an acceptable functional outcome after successful fracture-brace treatment. However, in simple (type A) fractures, the nonunion rate seems to be higher, and patients with healed nonunions after revision surgery reported worse functional outcomes. Based on these findings, it seems reasonable to explore the use of plate fixation compared with nonoperative treatment for selected fracture types in a randomized controlled trial.
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To assess the indications for, the demographics of, and the appropriateness of patient transfers for orthopedic injuries to a level I trauma center. ⋯ The need for an increased level of care was the predominant stated reason for patient transfer to our level I trauma center. Nonetheless, the orthopedic surgeon on call did not always examine the patient before transfer. Additionally, patients transferred who had a low level of complexity (those believed not to necessarily require tertiary care) had an insurance status that was worse than that of the typical transferred patient.
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Open reduction and internal fixation of proximal humerus fractures through the anterolateral acromial approach, which uses the anterior deltoid raphe and axillary nerve protection, has recently been advocated as a minimally invasive technique. Several recent reports have indicated variable and unpredictable vascular injuries to the humeral-head blood supply after a proximal humerus fracture, and thus a direct approach that minimizes further vascular compromise may be preferable. The purpose of this study was to define the relationship of this surgical interval to the lateral plating zone of the proximal humerus and to the penetrating vascular supply of the humeral head. ⋯ Minimally invasive techniques have many potential benefits for fracture healing, but new surgical approaches often must be used to take full advantage of these newer methods. Splitting the anterior deltoid raphe from the acromion distally allowed direct access to the lateral plating zone of the proximal humerus. The bare spot in this region may be a safe area for plate application, if the plate is placed appropriately with thorough knowledge of the vascular anatomy. These findings may be of particular importance if the vascular supply to the humeral head has already been partially compromised by preceding trauma. This direct approach to the lateral bare spot on the proximal humerus may minimize iatrogenic vascular injury when treating these fractures.
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To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol. ⋯ Treatment of fracture blisters with a silver sulfadiazine (Silvadene) regimen proved to be successful in minimizing soft-tissue complications by promoting re-epithelialization in all nondiabetic patients. At long-term follow-up, patients were generally satisfied with the cosmetic outcome of the treatment regimen. Postoperative scarring, which was more common with blood-filled blisters, significantly impacted patient satisfaction. We urge caution when planning to make a surgical incision around an area of both full-thickness (blood-filled) and partial-thickness (clear-filled) fracture blisters in diabetic patients because the zone of injury might extend beyond the borders of the fracture blister.